Problem of patient trust and sustainability: a care ethics response to Armitage

In a recent correspondence for this journal, Armitage questioned whether “it is ethically permissible to deploy sustainability-promoting interventions that knowingly reduce patient trust”.1 Armitage highlights the lack of ethical analysis prior to such interventions but does not indicate which ethical lens should guide further analysis of the tensions between sustainability and patient trust. We think this debate could be enriched by a naturalised account of informed consent and trust, as conceptualised by the care ethicist Joan Tronto.2 Tronto introduces ‘consent-as-authority’ to shift the meaning of consent away from a purely individualistic, autonomy-focused act, reframing it instead as a relational and political practice that authorises others to act within situations of dependence and power asymmetry. What does such a conceptualisation look like in practice?